“Together we are going to end the scourge of drug addiction in America,” Trump said. “We are going to end it or we are at least going to make a big dent into this terrible, terrible problem.”
The bill comes a year after Trump declared the opioid crisis to be a national emergency. More than 72,000 Americans died of drug overdoses in 2017, with 50,000 of those deaths attributed to opioids.
The most high-profile aspects of the bipartisan bill dealt directly with the drugs, including a provision to make it easier for nurses to prescribe buprenorphine, a narcotic that can be used to treat addiction, and a plan to require the U.S. Postal Service to screen international packages for the synthetic opioid fentanyl ― a driving force in the U.S. opioid epidemic that is often imported from China, Mexico and other countries.
Less discussed in coverage of the 660-page package was a handful of provisions that would specifically address how opioid use has affected children and families, which experts say could foster more understanding of childhood trauma and intergenerational addiction.
The new policies seek to increase support for parents with addiction, for former foster kids and for babies who are prenatally exposed to opioids. Other policies focus on better understanding the link between trauma and addiction, and using that data to design better treatments to mitigate the negative effects of childhood trauma.
“It recognizes that families are impacted and that many people who need substance use treatment are themselves parents, and have families to care for,” said Patricia Cole, senior director of federal policy at the children’s health nonprofit Zero to Three.
“We have to look at those family needs holistically, as opposed to just zeroing in only on the substance use.”
Here’s a breakdown of some of the key provisions aimed at supporting families and kids.
Allowing Families In Treatment To Stay Together
Several key provisions of the bill build upon the Family First Prevention Services Act, which passed in February and funds strategies for keeping vulnerable kids, including those whose parents have substance use disorders, out of the foster care system when possible.
Provisions in the new opioid package bolster that legislation by supporting what’s known as family-focused residential treatment facilities, where children can go with their parents while the adults get addiction treatment. The legislation also moves toward promoting evidence-based care and says state support should be informed by input from experts in addiction medicine, obstetrics, child trauma and child development.
“All too often, you hear of kids ending up with their grandparents or ending up in child welfare or being handed from family to family,” said Bradley Stein, a senior physician policy researcher at the nonprofit RAND Corporation.
Residential family-focused treatment is one effort to keep families intact.
“If you can get the family together into treatment, it’s more effective than the parent going [alone],” said Karen Howard, vice president for early childhood policy at First Focus, a children’s advocacy organization.
Plans To Safeguard Infants With Neonatal Opioid Exposure
There’s confusion about the best ways to treat babies who were exposed to opioids prenatally and how to keep them safe after discharge from the hospital. The lack of consistent policy puts them and their mothers in danger.
“I’m a practicing neonatologist and as we discharge infants home, the way we interact with the child welfare system is inconsistent in terms of developing plans of safe care,” said Dr. Stephen Patrick, director of Vanderbilt University School of Medicine’s Center for Child Health Policy.
“It oftentimes still feels really reactive around the time of discharge, instead of planning for the family holistically.”
A provision in the new opioid package calls on states to improve their plans for keeping infants exposed prenatally to opioids safe, including by providing developmental support for children and home nurse visitation, as well as addressing the mother’s addiction treatment needs.
“This bill provides much greater specificity around what a plan of safe care should be,” Patrick noted.
“I think this really has the potential to transform the way substance-exposed infants and their mothers are treated.”
Keeping Former Foster Kids Insured
Another provision in the new bill would allow former foster children who have aged out of foster care to remain on Medicaid until they turn 26, regardless of whether they move out of state. This is similar to other young adults who can stay on their parents’ health insurance until age 26.
Although states have five years to adopt the policy, Howard noted that the provision would be crucial to the 20,000 kids who age out of the foster system each year, including those who entered the foster care system because of their parents’ substance use disorders.
Young adults who were formerly in foster care are at higher risk for having multiple chronic health conditions, according to a study published in Pediatrics in 2014, making uninterrupted health insurance coverage even more vital.
“We don’t always focus in on what happened to the other kids aging out,” Cole noted. “We want them to be healthy.”
Learning More About Childhood Trauma
It’s well known that there’s a link between substance use disorder and childhood trauma, but what’s less defined is how to mitigate the negative effects of trauma as kids grow up.
Kids with parents who are dependent on opioids are both genetically at risk for substance use problems and at risk for substance use problems associated with the toxic stress of childhood trauma.
“It sets them on a trajectory of having increased likelihood of their own dependence issues,” said Sara Marques, director of strategic initiatives at the nonprofit Center for Youth Wellness.
The new opioid package speaks to that need by reauthorizing and providing funding to the National Traumatic Stress Initiative, as well as tasking the U.S. Centers for Disease Control and Prevention with collecting and reporting data on child, youth and adult trauma. There’s also an opportunity for grant funding to improve trauma and mental health support in schools.
An additional interagency task force would develop best practices for preventing and treating childhood trauma on a national level.
“It creates opportunity for expanding intervention and continuing to monitor what we know is the precursor to all of this, which is trauma,” Marques said. “Let’s figure out how we can use the science to better inform our response.”
Compared to the scope of the opioid crisis, the provisions aimed at children and families are modest ― and adequately funding these programs and initiatives will be key to their ultimate success.
While the new bill includes small grant programs, it doesn’t provide a significant increase in overall opioid funding, nor does it guarantee funding in subsequent years.
“Drug crises like these play out over decades,” said Stein. “This is a step in the right direction. It’s a first step or two down a much longer path.”